LifeShare Of The Carolinas
Routine Deceased Donor Orders - Pediatric
LifeShare Coordinator____________________________________ Blackberry # _____________________
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DO NOT initiate these orders until patient is declared brain dead and consent obtained for donation
Discontinue all previous orders except those specifically continued below
Discharge patient and readmit as “Organ Donor” prior to entering new orders
o Verify 2 hours of any necessary management drugs are available prior to discharging the patient
o Attending Physician/Responsible Party: LifeShare Of The Carolinas
Procedures:
______Arterial Line
______Triple or Quad Lumen Central Venous Catheter
______Swan Ganz
______Bronchoscopy – If available, please video record/photograph bronchoscopy
 Therapeutic and to assess for anatomical abnormalities
 Minimize lavage, avoid any unnecessary fluid
Obtain current Weight:____________ kg
Height:_______________ in
Cardiology:
_____Stat 12 lead EKG, NO Physician Interpretation Requested
_____Stat Echo (Verify timing with LifeShare Coordinator prior to ordering)
 If available, provide electronic copy of echo images.
 Stat read and dictated report (including estimated LVEF %) required.
Radiology:
_____ AP Portable CXR* (evaluation and measurements for potential organ donation)
 Obtain lung measurement worksheet from LifeShare. Radiologist should complete and return.
 If central access placement is pending, wait until completed to order
Laboratory:
_____ Type* and crossmatch for 2 units PRBC’s CMV negative. Keep 2 units available at all times.
 Subgroup A blood types.
 Leuko-reduced, if available
ALL LABS ARE STAT ORDERS
_____ CBC*
_____ CBC with Differential
_____ CMP*
_____ BMP*
_____ Hepatic Function Panel*
_____ PT/INR*
_____ PTT*
_____UA with Micro*
_____ Phosphorous
_____ Magnesium
_____ Direct Bili*
_____ Troponin I
_____ Fibrinogen
_____ Amylase/Lipase
_____ HgbA1C
Note to RN – DO NOT PERFORM POC TESTING UNLESS SPECIFICALLY REQUESTED OR ORDERED
BY THE LIFESHARE COORDINATOR.
_____Blood cultures* x 1 with sensitivity
 May obtain from Arterial and/or Central Venous Line if both/either are < 12 hours post insertion
_____Urine culture* and sensitivity
_____Bronchial washings for gram stain – to be obtained during bronchoscopy (order for potential lung donors only)
 1 BAL sample from each lung (if initial gram stains are positive, perform bacterial culture only)
9/26/2010
Page 1 of 3 – Pediatric
Verbal Order Medical Director and ____________________________________Date_____________Time___________ UNOS_______________
LifeShare Organ Recovery Coordinator
Pharmacy: All medications are STAT orders
_____Vasopressin: Mix 40 units in 250 ml NS; Dose= 0.5 milli-units/kg/hr
 May titrate at LifeShare’s direction to achieve desired urine output of __________ml/hr
_____Artificial Tears or Normal Saline - 2 drops per eye every 2 hrs and tape lids closed
Fluids:
_____ Maintenance IVF_____________________, infused at_________ml/hr, add _________mEq KCl
_____ Start urine replacement of______________, infused at ________ ml:ml/hr, add _______mEq KCl
 May titrate at LifeShare direction
Vasopressors: (Notify LifeShare if max dose is exceeded or if a significant change in vasopressor requirements occurs)
______Dopamine infusion titrating dose from 1-20 mcg/kg/min
______Epinephrine infusion titrating dose from 0.1-1 mcg/kg/min
______Phenylephrine infusion titrating dose from 0.1-0.5 mcg/kg/min
______Vasopressors listed below to maintain a SBP of _____________:
______________________________________________________________________________________
______________________________________________________________________________________
Antibiotics:
______Cefazolin (Ancef) 25mg/kg IV q 8 hrs (max: 1 gm/dose)
______Ceftazidime (Fortaz) 50mg/kg IV q 8 hrs (max: 2 gm/dose)
______Clindamycin (Cleocin) 10mg/kg IV q 6 hrs (max: 900 mg/dose)
______Ceftriaxone (Rocephin) 75 mg/kg IV daily
______Continue previous antibiotic coverage as follows – next dose due @ ______________________
____________________________________________________________________________
____________________________________________________________________________
Hormone Replacement Protocol: (Steroid, Insulin, Dextrose and Levothyroxine should be given in rapid succession)
______Methylprednisolone (SoluMedrol)
______30 mg/kg IV bolus (Total Dose=__________mgs)
______Repeat every 12 hrs
______Regular Insulin 0.1 units/kg IV (Total Dose=__________units)
______Dextrose
______D25
______< 6 months of age 1-2mL/kg IV bolus x 1 (0.25-0.5 gm/kg/dose), max = 25gm/dose
______> 6 months to 12 years of age 2-4mL/kg IV bolus x 1 (0.5-1 gm/kg/dose), max = 25gm/dose
______D50
______>12 years of age 50ml IV bolus x 1 (25 gm/dose)
______Levothyroxine: Mix 1000 mcg/50 ml NS (See chart below for dosing)
Bolus should be administered over 30 minutes and then start infusion as indicated below:
Check applicable
Age
Bolus (mcg/kg)
Infusion (mcg/kg/hr)
0-6 months
5
1.4
6-12 months
4
1.3
1-5 years
3
1.2
6-12 years
2.5
1
12-16 years
1.5
0.8
9/26/2010
Page 2 of 3 – Pediatric
Verbal Order Medical Director and ____________________________________Date_____________Time___________ UNOS_______________
LifeShare Organ Recovery Coordinator
Respiratory:
______Initiate Ventilator Management Orders (see attached)
_____Perform a Baseline ABG and an O2 Challenge at current ventilator settings (prior to Protocol initiation)
_____Perform Baseline ABG prior to each O2 Challenge requested by LifeShare
 O2 Challenges to be performed as specifically directed in the Orders
 Verbally report all ABGs to LifeShare and document Tidal Volume, MAP, Plateau Pressure, and all other
requested settings/parameters as directed on the LifeShare ABG Reporting Tool & Ventilator Worksheet.
 Follow guidelines on Orders for Ventilator Changes
 Additional Ventilator changes per LifeShare
 Chest PT and Rotation
_____ HOB elevated 30 degrees
_____Module rotation every 15 min. (side to side, never flat on back)
_____Percussion 15 min every 2 hrs if not contraindicated
_____IF NO MODULE AVAILABLE, Manual rotation (side to side, never flat on back) hourly
_____Frequent pulmonary toilet
 Auscultate lung fields every 2 hrs. Notify LifeShare of any changes in breath sounds/secretions.
 Suction:
 Each time if chest PT produces secretions
 Every 4 hrs if nonproductive and clear breath sounds
______Do not initiate the Ventilator Management Orders. RT (in collaboration with LifeShare) to maintain/manage
ventilator settings to optimize donor respiratory status.
 Maintain pH, PaCO2, and PaO2 within normal ranges, while minimizing FiO2.
 Verbally report ALL ABG results to LifeShare
_____Perform Baseline ABG now
_____Perform Baseline ABG every _____ hours
_____Perform Baseline ABGs as directed by LifeShare
 Rotation, PT, auscultation of lung fields prn to maintain O2 saturation of 96% or better
Nursing:
_____ NG/OG tube to low continuous wall suction prn
_____ Record VS every 15 minutes and CVP hourly
 Notify LifeShare Coordinator if:
 Heart Rate <__________ or > __________ beats/minute
 Systolic BP <__________ or >__________mmHg
 CVP <__________ or >__________mmHg
 Urine output < 1 ml/kg/hr or > 5ml/kg/hr
 O2 saturation < 96 %
 pH less than 7.35
_____ Blood Glucose checks every 1 hour
 Notify LifeShare Coordinator if > 150 mg/dL
_____ Maintain patient temperature at 96.0 – 101.0 degrees Fahrenheit
 Use warming blanket and/or Baer Hugger as needed
 Record temperature hourly
9/26/2010
Page 3 of 3 – Pediatric
Verbal Order Medical Director and ____________________________________Date_____________Time___________ UNOS_______________
LifeShare Organ Recovery Coordinator